New lung cancer screening guidelines could cost Medicare $9.3 billion

[May 15, 2014]  By Julie Steenhuysen

CHICAGO (Reuters) — A study of Medicare beneficiaries with a history of heavy smoking found that new lung cancer screening guidelines would likely double the proportion of lung cancers found at an early stage, but at a steep cost of some $9.3 billion over five years, U.S. researchers said on Wednesday.

The analysis, released ahead of the American Society for Clinical Oncology meeting from May 30 to June 3 in Chicago, estimates for the first time the cost of implementing new recommendations released last December by the U.S. Preventive Services Task Force.

The influential panel of independent experts, who advise U.S. policymakers, recommended that heavy smokers and former heavy smokers should get annual low-dose computed tomography, or CT scans, based on evidence that showed the benefits of screening outweigh the potential harms of over-diagnosis and overtreatment.

They gave screening a "B" recommendation, meaning the evidence of a benefit is at least moderately certain. Under President Barack Obama's Affordable Care Act, private insurers are required to cover preventive services with a grade of "B" or higher without a copay. The law does not require the Medicare health plan for people age 65 and older to do so.
 

The recommendation covers people aged 55 to 80 whose smoking has put them at high risk of cancer, so a large proportion of patients eligible for additional screening would be covered by Medicare.

A Medicare advisory panel on April 30 voted against covering the tests, citing a lack of evidence. The panel's decision is not binding, and Medicare is expected to issue a proposed coverage decision by November 2014.

One reason for the panel's vote was a lack of evidence about cost, Joshua Roth of the Fred Hutchinson Cancer Research Center in Seattle told reporters on a conference call.

The study by Roth and colleagues was designed to help fill in that gap. They used a mathematical model that calculated the cost of the screening over a five-year period, based on three scenarios.

Under the most likely scenario, which assumes half of people who are offered screening would get tested, doctors would order 11.2 million more CT scans, resulting in nearly 55,000 more lung cancers detected over five years versus no screening.

The group estimates that the program would more than double the proportion of cancers diagnosed at an early stage, increasing from 15 to 33 percent.

Including the cost of imaging, diagnostic work-up and care of newly detected cancers, the program would cost Medicare $9.3 billion over five years, amounting to an increase in Medicare spending of $3 per member, per month.

A more conservative screening estimate that assumes 25 percent of those offered would get screened each year would cost $5.9 billion over five years, while a more aggressive scenario assuming 75 percent of those eligible would get screened would cost as much as $12.7 billion.

ASCO President Dr Clifford Hudis said the study is a model, "not actual data," and stressed that while "low dose CT screening offers a long-awaited early lung cancer detection strategy," doctors must do everything they can to encourage patients to stop smoking and keep young adults from starting.

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Dan Grebler)

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